Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Resuscitation with crystalloid fluid is a cornerstone of pediatric septic shock treatment. However, the optimal type of crystalloid fluid is unknown. We aimed to determine the feasibility of conducting a pragmatic randomized trial to compare balanced (lactated Ringer's [LR]) with 0.9% normal saline (NS) fluid resuscitation in children with suspected septic shock. ⋯ A pragmatic study design proved feasible to study comparative effectiveness of LR versus NS fluid resuscitation for pediatric septic shock.
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Multicenter Study
Does Shared Decision-Making actually occur in the ED? Looking at it from the patients' perspective.
We sought to assess the frequency, content, and quality of shared decision making (SDM) in the emergency department (ED), from patients' perspectives. ⋯ Fewer than half of ED patients surveyed reported they were involved in SDM. The most common decision for which SDM was used was around ED disposition (admission vs. discharge). When SDM was employed, patients generally rated the discussion highly.
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The objective was to identify key questions for emergency medicine (EM)-based adolescent sexual and reproductive health and to develop an evidence-based research agenda. ⋯ We identified critical questions to inform EM-based adolescent sexual and reproductive health research. Because evidence-based care has potential to improve health outcomes while reducing costs associated with HIV/STI and unintended pregnancy, funders and researchers should consider increasing attention to these key questions.
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Randomized Controlled Trial
Video Discharge Instructions for Acute Otitis Media in Children: A Randomized Controlled Open-label Trial.
Thirty percent of children with acute otitis media (AOM) experience symptoms < 7 days after initiating treatment, highlighting the importance of comprehensive discharge instructions. ⋯ Video discharge instructions in the ED are associated with less perceived AOM symptomatology compared to a paper handout.
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Pediatric seizures are commonly encountered in emergency medical services (EMS). Evidence is accumulating that the rate of hypoglycemia in this setting is low, challenging the concept of routine prehospital glucose measurement. ⋯ Compliance is suboptimal, varying with patient age, race, and EMT-P presence. Testing increases when antiepileptic drugs are used. Hypoglycemia in tested patients was infrequent; however, proper treatment for hypoglycemic seizures will not be delivered if testing does not occur. It is worthwhile examining the utility of routine testing in this setting; however, until such time as protocols are revised, regional EMS administration should focus on education and uniform compliance with state protocols.